Eating Disorders Dr. Ahmed Elabwabi Abdelwahab MD. Psychiatry Assisstant professor Albaha university www.psychlotron.org.uk Eating Disorders Some statistics • Eating disorders have increased threefold in the last 50 years • 10% of the population is afflicted with an eating disorder • 90% of the cases are young women and adolescent girls • Up to 21% of college women show sub-threshold symptoms • 61% of college women show some sort of eating pathology Three Types of Eating Disorders • Anorexia nervosa- characterized by a pursuit of thinness that leads to self-starvation • Bulimia nervosa- characterized by a cycle of bingeing followed by extreme behaviors to prevent weight gain, such as purging. • Binge-eating disorder- characterized by regular bingeing, but do not engage in purging behaviors. • Anorexia is a misnomerappetite is normal Distorted body image. • Excess fear of fatness And excess emphasis on thinness. Anorexia Nervosa • Restriction of energy intake resulying in significant weight loss. • Poor sexual development in adolescents • Low sexual interest in adults Anorexia nervosa • May exhibit unusual behaviors with regards to food. – preoccupied with thoughts of food, and may show obsessive-compulsive tendencies related to food • may collect recipes or prepare elaborate meals for others. • Cutting foot into very small pieces. • Restrictive type: high restriction of food • Binge eating/purging type: –Regorous dieting with intermittent binging ( large amount of food in short period) –Uses: vomiting (or emetics use), laxatives, duiretics. Complications of anorexia nervosa Anorexia Risk of Death: The Deadliest of all Psychological Disorders Management • Admission and: – Restoring nutritional status – Manage complications such as dehydration and electrolyte imbalance. • Combination of behavioral ways and individual psychotherapy and family education. • SSRIs and TCAs may be tried. Bulimia Nervosa • Qualitatively distinct from anorexia • More common than anorexia nervosa. • characterized by: – binge eating – Inappropriate ways of avoiding weight gain. • A binge may or may not be planned – marked by a feeling of being out of control • The binge generally lasts until the individual is uncomfortably or painfully full Bulimia Nervosa • Usually in females. • Common triggers for a binge –dysphoric mood –interpersonal stressors –Intense hunger after a period of intense dieting or fasting –feelings related to weight, body shape, and food are common triggers to binge eating Bulimia Nervosa • Feelings of being ashamed after a binge are common – behavior is kept a secret • Tend to adhere to a pattern of restricted caloric intake – usually prefer low-calorie foods during times between binges More on bulimia nervosa • Later age at the onset of the disorder • Are able to maintain a normal weight • Will not seek treatment until they are ready • Most deal with the burden of hiding their problem for many years, sometimes well into their 30’s Two subtypes • purging type – self-induced vomiting and laxatives as a way to get rid of the extra calories they have taken in • non-purging type – use a period of fasting and excessive exercise to make up for the binge Complications of bulimia nervosa Management •CBT •SSRIs Risk Factors for developing an eating disorder –Personality/psychological factors –Family influence –Media –Subcultures existing within our society Personality/Psychological Factors • • • • • • Sense of self worth based on weight Use food as a means to feel in control Dichotomous & rigid thinking Perfectionism Poor impulse control Inadequate coping skills Media and Cultural Factors • Culture bound syndrome • Belief that being thin is the answer to all problems is prevalent in western culture • Bulimia can be influenced by social norms –It can be seen as a behavior, which is learned through modeling The Celebrity Thin Ideal Challenges to treatment • Lack of motivation to change – intrinsically reinforced by the weight loss, because it feels good to them – may deny the existence of the problem, or the severity of it Lack of insight – Not really about food.